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ELKasar AO, Hussien FZ, Abdel-Hamied HE, Saleh IG, Mahgoup EM, El-Arabey AA, Abd-Allah AR. Effect of lithium on chemotherapy-induced neutropenia in Egyptian breast cancer patients; a prospective clinical study. Cancer Chemother Pharmacol 2024; 93:541-554. [PMID: 38324036 DOI: 10.1007/s00280-023-04620-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/06/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE Myelosuppressive chemotherapy-induced neutropenia (CIN) remains a major limitation of cancer treatment efficacy, necessitating very expensive supportive care. Lithium carbonate, an inexpensive drug, can increase the number of neutrophils, possibly providing an efficacious and cost-effective alternative for treating CIN. The aim of this study was to determine whether lithium therapy can attenuate chemotherapy-induced neutropenia and leukopenia in breast cancer patients. METHODS A total of 50 breast cancer patients were enrolled in this prospective, interventional, randomized, controlled, and single-blind study. The patients were divided into two groups: a control group (group 1, N = 25 patients) and a lithium-treated (treatment) group (group 2, N = 25 patients). Group 1 patients were further subclassified into a non-neutropenic control group (N = 16) and a neutropenic control (N = 9) based on the subsequent development of severe neutropenia, or not. The control group received 4 cycles of doxorubicin or epirubicin plus cyclophosphamide followed by 2 cycles of paclitaxel. The treatment group received the same regimen as the control group as well as oral lithium carbonate throughout the chemotherapy cycles. RESULTS The results showed that the absolute neutrophil count (ANC) was increased in the lithium-treated group, while it was markedly reduced in both the non-neutropenic and neutropenic control groups (by 55.56% and 65.42% post-4 chemotherapy cycles, and by 19.57% and 39.90% post-6 cycles, respectively). The same pattern of alterations was observed for the total white blood cell count in both the control and treatment groups. In addition, the incidence and period prevalence were greatly reduced in the lithium-treated group compared to non-neutropenic and neutropenic control groups. CONCLUSION Lithium therapy ameliorated chemotherapy-induced leukopenia and neutropenia in breast cancer patients. This may provide a new strategy for cost-effective treatment of CIN, particularly in Egyptian cancer patients.
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Affiliation(s)
- Ahmed O ELKasar
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt
| | - Fatma Z Hussien
- Department of Clinical Oncology and Nuclear Medicine, Oncology Center, Faculty of Medicine, Tanta University Hospital, Tanta, Egypt
| | - Hala E Abdel-Hamied
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim G Saleh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt
| | - Elsayed M Mahgoup
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt.
| | - Amr A El-Arabey
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt
| | - Adel R Abd-Allah
- Department of Pharmacology and Toxicology, Faculty of Pharmacy (Boys), Al-Azhar University, Cairo, 11751, Egypt.
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Kanegusuku ALG, Chan CW, O'Donnell PH, Yeo KTJ. Implementation of pharmacogenomics testing for precision medicine. Crit Rev Clin Lab Sci 2024; 61:89-106. [PMID: 37776898 DOI: 10.1080/10408363.2023.2255279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/31/2023] [Indexed: 10/02/2023]
Abstract
Great strides have been made in the past decade to lower barriers to clinical pharmacogenomics implementation. Nevertheless, PGx consultation prior to prescribing therapeutics is not yet mainstream. This review addresses the current climate surrounding PGx implementation, focusing primarily on strategies for implementation at academic institutions, particularly at The University of Chicago, and provides an up-to-date guide of resources supporting the development of PGx programs. Remaining challenges and recent strategies for overcoming these challenges to implementation are discussed.
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Affiliation(s)
| | - Clarence W Chan
- Departments of Pathology, The University of Chicago, Chicago, IL, USA
| | - Peter H O'Donnell
- Department of Medicine, The University of Chicago, Chicago, IL, USA
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA
| | - Kiang-Teck J Yeo
- Departments of Pathology, The University of Chicago, Chicago, IL, USA
- Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA
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3
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Pereira L, Haidar CE, Haga SB, Cisler AG, Hall A, Shukla SK, Hebbring SJ, Leary EJW. Assessment of the current status of real-world pharmacogenomic testing: informed consent, patient education, and related practices. Front Pharmacol 2024; 15:1355412. [PMID: 38410134 PMCID: PMC10895424 DOI: 10.3389/fphar.2024.1355412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction: The practice of informed consent (IC) for pharmacogenomic testing in clinical settings varies, and there is currently no consensus on which elements of IC to provide to patients. This study aims to assess current IC practices for pharmacogenomic testing. Methods: An online survey was developed and sent to health providers at institutions that offer clinical germline pharmacogenomic testing to assess current IC practices. Results: Forty-six completed surveys representing 43 clinical institutions offering pharmacogenomic testing were received. Thirty-two (74%) respondents obtain IC from patients with variability in elements incorporated. Results revealed that twenty-nine (67%) institutions discuss the benefits, description, and purpose of pharmacogenomic testing with patients. Less commonly discussed elements included methodology and accuracy of testing, and laboratory storage of samples. Discussion: IC practices varied widely among survey respondents. Most respondents desire the establishment of consensus IC recommendations from a trusted pharmacogenomics organization to help address these disparities.
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Affiliation(s)
- Lucas Pereira
- Marshfield Clinic Research Institute, Center for Precision Medicine Research, Marshfield Clinic Health Systems, Marshfield, WI, United States
- Division of Genetics and Metabolism, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Cyrine-Eliana Haidar
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Susanne B Haga
- Program in Precision Medicine, Department of Medicine, School of Medicine, Duke University, Durham, NC, United States
| | - Anna G Cisler
- Medical Genetics, Marshfield Clinic Health Systems, Marshfield, WI, United States
| | - April Hall
- Division of Genetics and Metabolism, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
- Center for Human Genomics and Precision Medicine, Wisconsin Institute for Medical Research, University of Wisconsin-Madison, Madison, WI, United States
| | - Sanjay K Shukla
- Marshfield Clinic Research Institute, Center for Precision Medicine Research, Marshfield Clinic Health Systems, Marshfield, WI, United States
| | - Scott J Hebbring
- Marshfield Clinic Research Institute, Center for Precision Medicine Research, Marshfield Clinic Health Systems, Marshfield, WI, United States
| | - Emili J W Leary
- Marshfield Clinic Research Institute, Center for Precision Medicine Research, Marshfield Clinic Health Systems, Marshfield, WI, United States
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Young J, Jimenez A, Pruett M, Hancock L, Schruff M. A randomized controlled trial of analogue pharmacogenomic testing feedback for psychotropic medications. PEC INNOVATION 2023; 2:100119. [PMID: 37214496 PMCID: PMC10194257 DOI: 10.1016/j.pecinn.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 05/24/2023]
Abstract
Objective To examine the impact of various presentations of pharmacogenomic testing results using a published, color-coded decision support tool (DST) format as a standard stimulus to list possible medications. Methods Participants were randomly assigned to groups and asked to decide which psychotropic medication they would prefer if depressed. Three of the groups varied the color-coded category of fluoxetine and received a statement indicating that this was the most prescribed drug for depression. A fourth control condition omitted base rate information. Participants also provided detail about their decision-making processes through a qualitative interview. Results Comparison of the first three groups indicated that significantly more participants selected medications from the highest category of likely effectiveness when fluoxetine appeared in this list. Comparison of the control group to its relevant analogue suggested no significant differences in selection strategy. Qualitative interview responses indicated participant comfort with genetic testing despite awareness of having very limited understanding of these techniques and their implications. Conclusions Both DST color-coding and base rates were influential in driving drug selection decisions, despite most participants indicating they did not understand this information. Innovation Efforts to standardize pharmacogenomic stimuli may lead to advances in methods of studying quantifiable healthcare decisions. Attention to the context for presenting test results may also be a useful source of understanding patient responses, particularly regarding complex tests that are likely to be interpreted heuristically.
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Affiliation(s)
- John Young
- University of Mississippi, Department of Psychology, 207 Peabody Hall, University, MS 38677, USA
| | - Aileen Jimenez
- University of North Carolina at Chapel Hill, School of Pharmacy, 301 Pharmacy Lane, Chapel Hill, NC 27599, USA
| | - Madeline Pruett
- University of Mississippi, Department of Psychology, 207 Peabody Hall, University, MS 38677, USA
| | - Laken Hancock
- University of Mississippi, Department of Psychology, 207 Peabody Hall, University, MS 38677, USA
| | - McCall Schruff
- University of Mississippi, Department of Psychology, 207 Peabody Hall, University, MS 38677, USA
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5
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Omran S, Leong SL, Blebil A, Mohan D, Teoh SL. Effectiveness of pharmacogenomics educational interventions on healthcare professionals and health professions students: A systematic review. Res Social Adm Pharm 2023; 19:1399-1411. [PMID: 37586945 DOI: 10.1016/j.sapharm.2023.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The field of pharmacogenomics is rapidly advancing, but its adoption and implementation remain slow and lacking. Lack of pharmacogenomics knowledge among healthcare professionals is the most frequently cited barrier to adopting and implementing pharmacogenomics in clinical settings. OBJECTIVES This study aimed to critically evaluate and determine the effectiveness of educational interventions in improving pharmacogenomics knowledge and practice. METHODS Four electronic databases were searched: MEDLINE, EMBASE, CENTRAL, and PsycINFO. Studies on pharmacogenomics educational interventions for health care professionals and students with pre- and post-intervention assessments and results were included. No restrictions were placed on time, language, or educational contexts. The educational outcomes measured include both objective and subjective outcomes. The pharmacogenomics competency domains used to judge educational interventions are based on the competency domains listed by the American Association of Colleges of Pharmacies (AACP). The National Heart, Lung, and Blood Institute of the National Institutes of Health was used for the quality assessment of pre-post studies with no control group and the controlled intervention studies. No meta-analysis was conducted; the data were synthesized qualitatively. The systematic review was reported in accordance with the PRISMA statement. RESULTS Fifty studies were included in this review. All included studies integrated the AACP pharmacogenomics competency domains into their educational interventions. Most of the studies had educational interventions that integrated clinical cases (n = 44; 88%). Knowledge was the most frequently evaluated outcome (n = 34; 68%) and demonstrated significant improvement after the educational intervention that integrated AACP pharmacogenomics competency domains and employed active learning with clinical case inclusion. CONCLUSION This review provided evidence of the effectiveness of educational interventions in improving pharmacogenomics knowledge and practice. Incorporating pharmacogenomics competency domains into education and training, with patient cases for healthcare professionals and students, dramatically improved their pharmacogenomics knowledge, attitudes, and confidence in practice.
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Affiliation(s)
- Safa Omran
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
| | - Siew Lian Leong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Ali Blebil
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Devi Mohan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Siew Li Teoh
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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6
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Roberts B, Cooper Z, Lu S, Stanley S, Majda BT, Collins KRL, Gilkes L, Rodger J, Akkari PA, Hood SD. Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review. Front Pharmacol 2023; 14:1267294. [PMID: 37795032 PMCID: PMC10545970 DOI: 10.3389/fphar.2023.1267294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals' genetic variability in genes related to drug metabolism, PGx testing has the capabilities to individualise primary care and build a safer drug prescription model than the current "one-size-fits-all" approach. In particular, the use of PGx testing in psychiatry has shown promising evidence in improving drug efficacy as well as reducing toxicity and adverse drug reactions. Despite randomised controlled trials demonstrating an evidence base for its use, there are still numerous barriers impeding its implementation. This review paper will discuss the management of mental health conditions with PGx-guided treatment with a strong focus on youth mental illness. PGx testing in clinical practice, the concerns for its implementation in youth psychiatry, and some of the barriers inhibiting its integration in clinical healthcare will also be discussed. Overall, this paper provides a comprehensive review of the current state of knowledge and application for PGx in psychiatry and summarises the capabilities of genetic information to personalising medicine for the treatment of mental ill-health in youth.
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Affiliation(s)
- Bradley Roberts
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - Zahra Cooper
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
| | - Stephanie Lu
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Susanne Stanley
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | | | - Khan R. L. Collins
- Western Australian Department of Health, North Metropolitan Health Service, Perth, WA, Australia
| | - Lucy Gilkes
- School of Medicine, University of Notre Dame, Fremantle, WA, Australia
- Divison of General Practice, School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Jennifer Rodger
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Biological Sciences, University of Western Australia, Crawley, WA, Australia
| | - P. Anthony Akkari
- The Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- School of Human Sciences, University of Western Australia, Crawley, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Murdoch, WA, Australia
- Division of Neurology, Duke University Medical Centre, Duke University, Durham, United States
| | - Sean D. Hood
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley, WA, Australia
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Knepper TC, Boyle TA, Hicks JK, Walko CM. Pharmacist-Driven Precision Medicine: A Ferry to Cross the Chasm of Interpreting Biomarker Testing Reports. JCO Oncol Pract 2023; 19:679-680. [PMID: 37335971 DOI: 10.1200/op.23.00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/21/2023] Open
Abstract
Pharmacists as molecular oncology subspecialists can be integral to the multidisciplinary precision oncology team.
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Affiliation(s)
- Todd C Knepper
- Todd C. Knepper, PharmD, Precision Medicine Program, Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL; Theresa A. Boyle, MD, PhD, Molecular Pathology, Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; J. Kevin Hicks PhD, PharmD and Christine M. Walko, PharmD, Precision Medicine Program, Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL
| | - Theresa A Boyle
- Todd C. Knepper, PharmD, Precision Medicine Program, Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL; Theresa A. Boyle, MD, PhD, Molecular Pathology, Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; J. Kevin Hicks PhD, PharmD and Christine M. Walko, PharmD, Precision Medicine Program, Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL
| | | | - Christine M Walko
- Todd C. Knepper, PharmD, Precision Medicine Program, Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL; Theresa A. Boyle, MD, PhD, Molecular Pathology, Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL; J. Kevin Hicks PhD, PharmD and Christine M. Walko, PharmD, Precision Medicine Program, Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL
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Makrygianni D, Koufaki MI, Patrinos GP, Vasileiou KZ. Pharmacy students' attitudes and intentions of pursuing postgraduate studies and training in pharmacogenomics and personalised medicine. Hum Genomics 2023; 17:27. [PMID: 36959668 PMCID: PMC10035981 DOI: 10.1186/s40246-023-00474-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Pharmacists' contribution to pharmacogenomics (PGx) implementation in clinical practice is vital, but a great proportion of them are not aware of PGx and its applications. This highlights the university education's crucial role to prepare pharmacists to face future challenges in such a constantly evolving and demanding environment. OBJECTIVES Our study aims to examine pharmacy students' training satisfaction, knowledge, self-confidence and attitudes towards PGx on their intentions for postgraduate training in PGx and personalised medicine (PM). METHODS An initial model on students' intention to pursue postgraduate training in PGx and PM and its predicting factors, based on the Theory of Planned Behaviour (TPB), was proposed. Based on it, a questionnaire was developed and distributed to 346 pharmacy students of all study years, capturing the selected factors influencing students' intentions to postgraduate training in PGx and PM, as well as their demographics. Structural equation modelling (SEM) analysis was employed to determine the effects of both the examined factors and demographics on students' intentions. RESULTS Students did not consider themselves adequately prepared for using PGx in clinical practice. Their attitudes towards PGx implementation were the most important factor influencing their intentions to pursue postgraduate training in PGx and PM. Other factors such as self-confidence and training satisfaction also affected students' intentions, but to a lower extent. Students of the last two study years (40% of the whole sample) and male (36%) students stated to be less willing to pursue PGx-related studies in the future. Only 10% of the participants claimed to have undergone a recent PGx or genetic test, but this did not affect their intentions. CONCLUSION There is an important gap in pharmacy school curriculum regarding PGx and PM training which coupled with the slow rate of PGx and PM implementation into clinical practice seems to restrain students' aspiration to further expand their knowledge and horizons in terms of PGx and PM.
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Affiliation(s)
- Dimitra Makrygianni
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, University Campus, 26504, Patras, Greece
| | - Margarita-Ioanna Koufaki
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, University Campus, 26504, Patras, Greece
| | - George P Patrinos
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, University Campus, 26504, Patras, Greece
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates
- Zayed Center for Health Sciences, United Arab Emirates University, Al-Ain, Abu Dhabi, United Arab Emirates
| | - Konstantinos Z Vasileiou
- Laboratory of Pharmacogenomics and Individualized Therapy, Department of Pharmacy, University of Patras School of Health Sciences, University Campus, 26504, Patras, Greece.
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9
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Pasternak AL, Ward K, Irwin M, Okerberg C, Hayes D, Fritsche L, Zoellner S, Virzi J, Choe HM, Ellingrod V. Identifying the prevalence of clinically actionable drug-gene interactions in a health system biorepository to guide pharmacogenetics implementation services. Clin Transl Sci 2022; 16:292-304. [PMID: 36510710 PMCID: PMC9926071 DOI: 10.1111/cts.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 12/15/2022] Open
Abstract
Understanding patterns of drug-gene interactions (DGIs) is important for advancing the clinical implementation of pharmacogenetics (PGx) into routine practice. Prior studies have estimated the prevalence of DGIs, but few have confirmed DGIs in patients with known genotypes and prescriptions, nor have they evaluated clinician characteristics associated with DGI-prescribing. This retrospective chart review assessed prevalence of DGI, defined as a medication prescription in a patient with a PGx phenotype that has a clinical practice guideline recommendation to adjust therapy or monitor drug response, for patients enrolled in a research genetic biorepository linked to electronic health records (EHRs). The prevalence of prescriptions for medications with pharmacogenetic (PGx) guidelines, proportion of prescriptions with DGI, location of DGI prescription, and clinical service of the prescriber were evaluated descriptively. Seventy-five percent (57,058/75,337) of patients had a prescription for a medication with a PGx guideline. Up to 60% (n = 26,067/43,647) of patients had at least one DGI when considering recommendations to adjust or monitor therapy based on genotype. The majority (61%) of DGIs occurred in outpatient prescriptions. Proton pump inhibitors were the most common DGI medication for 11 of 12 clinical services. Almost 25% of patients (n = 10,706/43,647) had more than one unique DGI, and, among this group of patients, 61% had a DGI with more than one gene. These findings can inform future clinical implementation by identifying key stakeholders for initial DGI prescriptions, helping to inform workflows. The high prevalence of multigene interactions identified also support the use of panel PGx testing as an implementation strategy.
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Affiliation(s)
- Amy L. Pasternak
- Department of Clinical PharmacyUniversity of Michigan College of PharmacyAnn ArborMichiganUSA,Michigan MedicineUniversity of Michigan HealthAnn ArborMichiganUSA
| | - Kristen Ward
- Department of Clinical PharmacyUniversity of Michigan College of PharmacyAnn ArborMichiganUSA,Michigan MedicineUniversity of Michigan HealthAnn ArborMichiganUSA
| | - Madison Irwin
- Department of Clinical PharmacyUniversity of Michigan College of PharmacyAnn ArborMichiganUSA,Michigan MedicineUniversity of Michigan HealthAnn ArborMichiganUSA
| | - Carl Okerberg
- Michigan MedicineUniversity of Michigan HealthAnn ArborMichiganUSA
| | - David Hayes
- Department of Clinical PharmacyUniversity of Michigan College of PharmacyAnn ArborMichiganUSA
| | - Lars Fritsche
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Sebastian Zoellner
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - Jessica Virzi
- Michigan MedicineUniversity of Michigan HealthAnn ArborMichiganUSA
| | - Hae Mi Choe
- Department of Clinical PharmacyUniversity of Michigan College of PharmacyAnn ArborMichiganUSA,Michigan MedicineUniversity of Michigan HealthAnn ArborMichiganUSA
| | - Vicki Ellingrod
- Department of Clinical PharmacyUniversity of Michigan College of PharmacyAnn ArborMichiganUSA
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10
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Gallaway KA, Sakon C, Ongeri J, Patel KS, Oliver J, Patacca H, O'Brien ARW, Skaar TC, Tillman EM. Opportunity for pharmacogenetics testing in patients with sickle cell anemia. Pharmacogenomics 2022; 23:925-931. [DOI: 10.2217/pgs-2022-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Patients with sickle cell disease (SCD) are exposed to numerous drugs over their lifespan, and many of these drugs have Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for personalized dosing. The authors' aim was to ascertain the number of drugs with CPIC guidelines prescribed to SCD patients. Materials & methods: A search of Indiana University Health affiliated hospitals' electronic medical record identified 957 patients with a diagnosis of SCD. Drugs or drug classes with CPIC actionable guidelines ordered as inpatient and outpatient prescriptions were collected from SCD patients. Results: During the 16-year period, 892 (93%) patients received at least one drug that could have been dosed according to CPIC guidelines. Conclusion: Preemptive pharmacogenetics testing should be considered in SCD patients in order to utilize these data throughout the patient's life.
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Affiliation(s)
- Katherine A Gallaway
- Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Colleen Sakon
- Pharmacy Department, Indiana University Health, Indianapolis, IN 46202, USA
| | - Jefney Ongeri
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Krina S Patel
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Johnathan Oliver
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Heather Patacca
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Andrew RW O'Brien
- Division of Hematology and Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Todd C Skaar
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Emma M Tillman
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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11
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Pasupuleti D, Nguyen T, Nahta R. Using Online Cancer Genomics Databases to Provide Teaching Resources for Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:ajpe8683. [PMID: 34507956 PMCID: PMC10159395 DOI: 10.5688/ajpe8683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/30/2021] [Indexed: 05/06/2023]
Abstract
Connecting scientific concepts with clinical applications is an important objective of pharmacy education. As the field of precision oncology expands, it is critical for pharmacy students to understand how genetic information informs cancer treatment decisions. However, to effectively teach students about pharmacogenomics and pharmacogenetics, faculty require relevant educational resources, including those that support higher-order learning. In this Commentary, we demonstrate the potential utility of publicly accessible cancer genomics databases as teaching resources for pharmacogenomics and pharmacogenetics in oncology pharmacy education. Using clinical data retrieved from a genomics database, we illustrate how case studies can be developed to target core competencies, including understanding tumor genomics profiling, somatic mutations and pharmacotherapy selection, and clinical pharmacogenetics testing. Cancer genomics databases provide readily available, cost-effective, clinical data resources that support active learning related to pharmacogenomics and pharmacogenetics education in oncology pharmacy curricula.
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Affiliation(s)
| | - Tro Nguyen
- Mercer University, College of Pharmacy, Atlanta, Georgia
| | - Rita Nahta
- Mercer University, College of Pharmacy, Atlanta, Georgia
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12
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Wen YF, Jacobson PA, Oetting WS, Pereira C, Brown JT. Knowledge and attitudes of incoming pharmacy students toward pharmacogenomics and survey reliability. Pharmacogenomics 2022; 23:873-885. [DOI: 10.2217/pgs-2022-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims: To assess knowledge and attitudes toward pharmacogenomics (PGx) of incoming doctoral pharmacy students, to evaluate the internal structure and reliability of the PGx survey and to identify variables associated with the different responses. Methods: A PGx survey based on the core pharmacist competencies in PGx was created. Results: Of 83.2% analyzable responses, 91% believed PGx is a useful tool and relevant to future practice but over 70% stated they lack confidence in clinical PGx knowledge. This 38-item PGx survey included three factors showing high reliability. Prior genetic/PGx testing and unsatisfactory medication experiences were associated with a more positive attitude toward PGx. Conclusion: The majority of students have positive attitudes toward PGx, but lack knowledge in genetic concepts and clinical PGx.
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Affiliation(s)
- Ya-Feng Wen
- Department of Experimental & Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Pamala A Jacobson
- Department of Experimental & Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - William S Oetting
- Department of Experimental & Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Chrystian Pereira
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jacob T Brown
- Department of Pharmacy Practice & Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN 55812, USA
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Venugopal ML, Yong FR, Krzyzaniak N, La Caze A, Freeman C. Mapping Australian pharmacy school curricula for content related to pharmacogenomics. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 8:100192. [PMID: 36299640 PMCID: PMC9589202 DOI: 10.1016/j.rcsop.2022.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background Pharmacogenomics (PGx) is a rapidly growing field which promises to deliver personalized, more effective medications tailored to genetic information. Although the pharmacy profession is expected to lead the translation of pharmacogenomics into widespread clinical implementation, there is a reported lack of preparedness among its members. Assessing pharmacogenomic-related training in Australian pharmacy program curricula may highlight educational gaps and provide guidance for curricula revision. Objective To examine pharmacogenomic content in Australian tertiary pharmacy program curricula. Methods We reviewed the curriculum of 22 Australian registrable pharmacy degrees, including 16 Bachelors of Pharmacy programs (with or without honors) and six Masters of Pharmacy programs, for content related to pharmacogenomics and genetics. This was done by screening the publicly available electronic course profiles on each institution's website and searching for key terms such as "pharmacogenomics," "pharmacogenetics," "genes," and "genetics". Three mapping activities were completed to assess the breadth and depth of pharmacogenomic training according to; 1. Bloom's taxonomy, 2. Author-assigned domains comprising; Enabling science, Translational science and Clinical implementation, and 3. Pharmacogenomic competencies from the National Human Genome Research Institute (NHGRI). Results A total of 18 (82%) pharmacy registrable degree programs incorporated pharmacogenomics and/or genetics in their curricula. Four programs (18%) offered standalone PGx courses and 10 (45%) contained integrated PGx content in other science-related courses (i.e. pharmaceutical biology, biochemistry, microbiology etc.). Mapping activities showed that most learning objectives related to the "Understand" level of Bloom's taxonomy (61%), the "Basic Genetic Concepts" domain of NHGRI's competencies (64%) and "Enabling science" (84%). Conclusions Most Australian pharmacy registrable degrees have incorporated pharmacogenomic content in their curricula however, the scope of training is limited. Revisions to course curricula should be made to incorporate additional education with a focus on application-based training of clinical pharmacogenomics.
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Affiliation(s)
- Maija-Liisa Venugopal
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Faith R. Yong
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Natalia Krzyzaniak
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Adam La Caze
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Christopher Freeman
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Woolloongabba, QLD 4102, Australia,Metro North Hospital and Health Service, Herston, Australia,Corresponding author.
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14
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Naimat F, Fahrni ML, Purushothaman S, Abdul Ghani MN, Chumnumwat S, Babar ZUD. Community pharmacists’ perceived value on precision medicine, desired training components, and exposure during pharmacy education: Malaysia’s experience. Front Pharmacol 2022; 13:978141. [PMID: 36238562 PMCID: PMC9552318 DOI: 10.3389/fphar.2022.978141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Precision medicine beckons new horizons for therapy geared to one’s genetics, lifestyle, and environmental determinants. Molecular, pathology, and clinical diagnostics can be integrated to provide pharmaceutical care.Aims: The value and appeal of precision medicine to community pharmacists, knowledge attained, and training programmes perceived as necessary were evaluated.Methods: Over 10 months, a published questionnaire, which was also digitally accessible during the COVID-19 outbreak, was distributed by hand, via email and social media. 300 community pharmacists across 9 districts in an urban state in Malaysia, self-administered and returned completed versions (response rate 75%). Three- or five-point Likert scale and multiple-choice responses were analysed using SPSS to assess whether or not exposure through the pharmacy curricula impacted current knowledge, perception and willingness to pursue precision medicine.Results: Respondents were largely: females (N = 196, 65.3%) and practicing for up to 10 years (N = 190, 66.3%). Although knowledge levels were moderate (76%), positive perceptions were showcased (94%), and 80% were willing to integrate precision medicine into their daily practice. Although 61% did not or do not recall having had prior exposure to pharmacogenomics as part of their pharmacy school curricula, many (93%) were willing to attain knowledge by undergoing additional training. Desired training included current pharmacogenetic testing available (17%), interpretation of the test results (15%), and ethical considerations (13%). Community pharmacists who had 0.5–10 years’ work experience possessed greater knowledge (μ = 1.48, CI 1.35–1.61, p = 0.017), than the pharmacists who had 21–40 years of work experience (μ = 1.28, CI 1.05–1.51, p = 0.021). Exposure to the subject during pharmacy education positively impacted the willingness to integrate precision medicine in daily practice (p = 0.035).Conclusion: Community pharmacists were receptive to and valued precision medicine. A relatively high number had prior exposure to concepts of precision medicine through the pharmacy curriculum, and were therefore willing to adopt the practice in their day-to-day provision of healthcare. With adequate training centred on bioethics, utilising pharmacogenetic testing, and interpretation of the results, community pharmacists will be equipped for the provision of precision medicine services in the foreseeable future.
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Affiliation(s)
- Faiza Naimat
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam, Selangor, Malaysia
- School of Pharmacy, Management and Science University, Shah Alam, Malaysia
| | - Mathumalar Loganathan Fahrni
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Puncak Alam, Selangor, Malaysia
- Collaborative Drug Discovery Research (CDDR) Group, Communities of Research (Pharmaceutical and Life Sciences), Universiti Teknologi MARA (UiTM), Puncak Alam, Selangor, Malaysia
- *Correspondence: Mathumalar Loganathan Fahrni,
| | - Shankar Purushothaman
- School of Pharmacy, Management and Science University, Shah Alam, Malaysia
- Department of Pharmacy, Hospital Shah Alam, Shah Alam, Selangor, Malaysia
| | | | - Supatat Chumnumwat
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
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15
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Gammal RS, Fieg E. Pharmacist and genetic counselor collaboration in pharmacogenomics. Am J Health Syst Pharm 2022; 79:1516-1520. [PMID: 35732271 DOI: 10.1093/ajhp/zxac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Affiliation(s)
- Roseann S Gammal
- Massachusetts College of Pharmacy and Health Sciences Boston, MA, USA
| | - Elizabeth Fieg
- Genetics & Genomic Medicine Service Brigham and Women's Hospital Boston, MA, USA
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16
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Formea CM, Schultz AJ, Empey PE. Pharmacists Closing Health Disparity Gaps through Pharmacogenomics. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christine M. Formea
- Intermountain Healthcare, Department of Pharmacy Services Salt Lake City Utah
- Intermountain Precision Genomics, Intermountain Healthcare St. George Utah
| | - April J. Schultz
- Sanford Imagenetics, Sanford Health Sioux Falls South Dakota
- Sanford USD School of Medicine University of South Dakota Sioux Falls South Dakota
| | - Philip E. Empey
- School of Pharmacy University of Pittsburgh Pittsburgh Pennsylvania
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17
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Martin JL, Lee YM, Corbin LW, Colson R, Aquilante CL. Patients' perspectives of a pharmacist-provided clinical pharmacogenomics service. Pharmacogenomics 2022; 23:463-474. [PMID: 35469451 DOI: 10.2217/pgs-2022-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: To assess the perspectives and experiences of patients who participated in a pharmacist-provided clinical pharmacogenomics (PGx) service. Methods: We conducted individual semistructured interviews with 16 patients who received a pharmacist-provided PGx service. Qualitative data were analyzed to identify pertinent themes. Results: The major themes identified were: heterogeneity of patient PGx experiences and preferences, pharmacists as appropriate providers of PGx services, considerations regarding the use of PGx results in routine healthcare, and perceived applications of PGx testing. Theme-derived considerations included the need to establish appropriate pre-genotyping expectations, individualize patient education, facilitate collaboration with patients' providers and sustainably update patients' PGx information over time. Conclusion: Patient-specific perspectives such as these are important to consider when providing clinical PGx services, with intention of optimizing patient experiences.
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Affiliation(s)
- James L Martin
- Department of Pharmaceutical Sciences, University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Yee Ming Lee
- Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
| | - Lisa W Corbin
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Ronald Colson
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado, Skaggs School of Pharmacy & Pharmaceutical Sciences, Aurora, CO 80045, USA
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18
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Gammal RS, Lee YM, Petry NJ, Iwuchukwu O, Hoffman JM, Kisor DF, Empey PE. Pharmacists Leading the Way to Precision Medicine: Updates to the Core Pharmacist Competencies in Genomics. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8634. [PMID: 34301570 PMCID: PMC10159420 DOI: 10.5688/ajpe8634] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/23/2021] [Indexed: 05/06/2023]
Abstract
Genomics is becoming an increasingly important part of health care, and pharmacists are well-positioned to be practice-based leaders in pharmacogenomics and precision medicine. Competencies available through the Genetics/Genomics Competency Center provide a framework for pharmacogenomics instruction in both pharmacy school curricula and continuing education programs. Given the significant advancements in pharmacogenomics over the past decade, the 2019-2020 American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group updated the pharmacist competencies. The process used a systematic approach which included mapping pharmacogenomics-specific competencies to the entrustable professional activities for pharmacists and seeking consensus from key stakeholders. The result is an expansion to 30 competencies that reflect the contemporary roles pharmacists play in the application of pharmacogenomics in clinical practice. When implemented into curricula, these competencies will ensure that learners are "practice ready" to integrate pharmacogenomics into patient care. Additional postgraduate training is needed for advanced roles in pharmacogenomics implementation, education, and research.
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Affiliation(s)
- Roseann S Gammal
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts
| | - Yee Ming Lee
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Natasha J Petry
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- North Dakota State University, School of Pharmacy, Fargo, North Dakota
| | - Otito Iwuchukwu
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- Farleigh Dickinson University, School of Pharmacy, Florham Park, New Jersey
| | - James M Hoffman
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - David F Kisor
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- Manchester University, Fort Wayne, Indiana
| | - Philip E Empey
- American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group, Arlington, Virginia
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
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19
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Sakon C, Alicea LA, Patacca H, Brown CD, Skaar TC, Tillman EM. Opportunity for pharmacogenomic testing in patients with cystic fibrosis. Pediatr Pulmonol 2022; 57:903-907. [PMID: 34967155 DOI: 10.1002/ppul.25809] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/06/2021] [Accepted: 12/28/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with cystic fibrosis (CF) are exposed to many drugs in their lifetime and many of these drugs have Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines that are available to guide dosing. Contemporary CF treatments are targeted to specific mutations in the CF transmembrane conductance regulator (CFTR) gene, and thus, require patients to have genetic testing before initiation of modulator therapy. However, aside from CFTR genetic testing, pharmacogenomic testing is not standard of care for CF patients. AIM The aim of this study is to determine the number of non-CFTR modulator medications with CPIC guidelines that are prescribed to patients with CF. MATERIALS & METHODS We identified all patients with a diagnosis of CF and queried our hospital electronic medical records (EMR) for all orders, including inpatient and prescriptions, for all drugs or drug classes that have CPIC actionable guidelines for drug-gene pairs that can be used to guide therapy. RESULTS We identified 576 patients with a diagnosis of CF that were treated at our institution during this 16-year period between June 2005 and May 2021. Of these patients, 504 patients (87.5%) received at least one drug that could have been dosed according to CPIC guidelines if pharmacogenomic results would have been available. CONCLUSIONS Patients with CF have high utilization of drugs with CPIC guidelines, therefore preemptive pharmacogenomic testing should be considered in CF patients at the time of CFTR genetic testing.
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Affiliation(s)
- Colleen Sakon
- Pharmacy Department, Indiana University Health, Indianapolis, Indiana, USA
| | - Leah A Alicea
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Heather Patacca
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Cynthia D Brown
- Division of Pulmonary and Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Todd C Skaar
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Emma M Tillman
- Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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20
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Smith DM, Stevenson JM, Ho TT, Formea CM, Gammal RS, Cavallari LH. Pharmacogenetics: A Precision Medicine Approach to Combatting the Opioid Epidemic. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:239-250. [PMID: 35784584 PMCID: PMC9248444 DOI: 10.1002/jac5.1582] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ineffective pain control is the most commonly cited reason for misuse of prescription opioids and is influenced by genetics. In particular, the gene encoding the CYP2D6 enzyme, which metabolizes some of the most commonly prescribed opioids (e.g., tramadol, hydrocodone) to their more potent forms, is highly polymorphic and can lead to reduced concentrations of the active metabolites and decreased opioid effectiveness. Consideration of the CYP2D6 genotype may allow for predicting opioid response and identifying patients who are likely to respond well to lower potency opioids as well as those who may derive greater pain relief from non-opioid analgesics versus certain opioids. There is emerging evidence that a CYP2D6-guided approach to pain management improves pain control and reduces opioid consumption and thus may be a promising means for combating opioid misuse. Clinical practice guidelines are available for select opioids and other analgesics to support medication and dose selection based on pharmacogenetic data. This article describes the evidence supporting genotype-guided pain management as a means of improving pain control and reducing opioid misuse and clinical recommendations for genotype-guided analgesic prescribing. In addition, a "how to" guide using patient case examples is provided to demystify the process for implementing pharmacogenetics-guided pain management in order to optimize analgesia and minimize adverse effects. Optimizing pain management through genotype-guided approaches may ultimately provide safer and more effective therapy for pain control while decreasing the risk for opioid misuse.
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Affiliation(s)
- D. Max Smith
- MedStar Health, Columbia, Maryland, USA.,Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - James M. Stevenson
- Division of Clinical Pharmacology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Teresa T. Ho
- Department of Pharmacotherapeutics and Clinical Research, University of South Florida, Tampa, Florida, USA
| | - Christine M. Formea
- Department of Pharmacy and Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Roseann S. Gammal
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, Massachusetts, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, Florida, USA.,Center for Pharmacogenomics and Precision Medicine, University of Florida, Gainesville, Florida, USA
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21
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Lee AJ, Hui AC, Walker AD, Peshkin BN, Swain SM, Smith DM. Evaluation of a longitudinal pharmacogenomics education on pharmacist knowledge in a multicampus healthcare system. Pharmacogenomics 2022; 23:173-182. [PMID: 35042388 DOI: 10.2217/pgs-2021-0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: To evaluate the effect of pharmacogenomics (PGx) education for pharmacists. Materials & Methods: Three-part weekly webinar series occurred in 2021. Pharmacists were assessed on their PGx knowledge at baseline and after each webinar. The primary end point was a change in the percent of correct responses between the baseline and week 1 assessment. Secondary end points included change in knowledge at weeks 4-8 and change in self-efficacy. Results: In total, 19 of 58 participants were eligible for the primary analysis, which showed an average improvement of 37% (p < 0.0001). Knowledge remained consistent between week 1 and weeks 4-8. Average self-efficacy increased (p < 0.0001) and was maintained at weeks 4-8. Conclusion: The PGx webinar series resulted in a lasting improvement in PGx knowledge and self-efficacy.
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Affiliation(s)
- Andrew J Lee
- Department of Pharmacy, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | - Adrian C Hui
- Department of Pharmacy, MedStar Union Memorial Hospital, Baltimore, MD 21218, USA
| | | | - Beth N Peshkin
- Georgetown University Medical Center, Washington, DC 20057, USA
| | - Sandra M Swain
- MedStar Health, Columbia, MD 21044, USA.,Georgetown University Medical Center, Washington, DC 20057, USA
| | - D Max Smith
- MedStar Health, Columbia, MD 21044, USA.,Georgetown University Medical Center, Washington, DC 20057, USA
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22
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Pardiñas AF, Owen MJ, Walters JTR. Pharmacogenomics: A road ahead for precision medicine in psychiatry. Neuron 2021; 109:3914-3929. [PMID: 34619094 DOI: 10.1016/j.neuron.2021.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/05/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
Psychiatric genomics is providing insights into the nature of psychiatric conditions that in time should identify new drug targets and improve patient care. Less attention has been paid to psychiatric pharmacogenomics research, despite its potential to deliver more rapid change in clinical practice and patient outcomes. The pharmacogenomics of treatment response encapsulates both pharmacokinetic ("what the body does to a drug") and pharmacodynamic ("what the drug does to the body") effects. Despite early optimism and substantial research in both these areas, they have to date made little impact on clinical management in psychiatry. A number of bottlenecks have hampered progress, including a lack of large-scale replication studies, inconsistencies in defining valid treatment outcomes across experiments, a failure to routinely incorporate adverse drug reactions and serum metabolite monitoring in study designs, and inadequate investment in the longitudinal data collections required to demonstrate clinical utility. Nonetheless, advances in genomics and health informatics present distinct opportunities for psychiatric pharmacogenomics to enter a new and productive phase of research discovery and translation.
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Affiliation(s)
- Antonio F Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Michael J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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Taddeo A, Prim D, Bojescu ED, Segura JM, Pfeifer ME. Point-of-Care Therapeutic Drug Monitoring for Precision Dosing of Immunosuppressive Drugs. J Appl Lab Med 2021; 5:738-761. [PMID: 32533157 DOI: 10.1093/jalm/jfaa067] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/03/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Immunosuppressive drugs (ISD) are an essential tool in the treatment of transplant rejection and immune-mediated diseases. Therapeutic drug monitoring (TDM) for determination of ISD concentrations in biological samples is an important instrument for dose personalization for improving efficacy while reducing side effects. While currently ISD concentration measurements are performed at specialized, centralized facilities, making the process complex and laborious for the patient, various innovative technical solutions have recently been proposed for bringing TDM to the point-of-care (POC). CONTENT In this review, we evaluate current ISD-TDM and its value, limitations, and proposed implementations. Then, we discuss the potential of POC-TDM in the era of personalized medicine, and provide an updated review on the unmet needs and available technological solutions for the development of POC-TDM devices for ISD monitoring. Finally, we provide concrete suggestions for the generation of a meaningful and more patient-centric process for ISD monitoring. SUMMARY POC-based ISD monitoring may improve clinical care by reducing turnaround time, by enabling more frequent measurements in order to obtain meaningful pharmacokinetic data (i.e., area under the curve) faster reaction in case of problems and by increasing patient convenience and compliance. The analysis of the ISD-TDM field prompts the evolution of POC testing toward the development of fully integrated platforms able to support clinical decision-making. We identify 4 major areas requiring careful combined implementation: patient usability, data meaningfulness, clinicians' acceptance, and cost-effectiveness.
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Affiliation(s)
- Adriano Taddeo
- Institute of Life Technologies - School of Engineering, HES-SO//University of Applied Sciences, Western Switzerland, Sion, Switzerland
| | - Denis Prim
- Institute of Life Technologies - School of Engineering, HES-SO//University of Applied Sciences, Western Switzerland, Sion, Switzerland
| | - Elena-Diana Bojescu
- Institute of Life Technologies - School of Engineering, HES-SO//University of Applied Sciences, Western Switzerland, Sion, Switzerland
| | - Jean-Manuel Segura
- Institute of Life Technologies - School of Engineering, HES-SO//University of Applied Sciences, Western Switzerland, Sion, Switzerland
| | - Marc E Pfeifer
- Institute of Life Technologies - School of Engineering, HES-SO//University of Applied Sciences, Western Switzerland, Sion, Switzerland
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24
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Adesta F, Mahendra C, Junusmin KI, Rajah AMS, Goh S, Sani L, Chan A, Irwanto A. Pharmacogenomics Implementation Training Improves Self-Efficacy and Competency to Drive Adoption in Clinical Practice. Front Pharmacol 2021; 12:684907. [PMID: 34262455 PMCID: PMC8273230 DOI: 10.3389/fphar.2021.684907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Administration of pharmacogenomics (PGx) testing in clinical practice has been suboptimal, presumably due to lack of PGx education. Here, we aim to evaluate the standpoint of PGx testing among a diverse group of healthcare professionals (HCPs) through conducting surveys before and after training. Materials and Methods: Training modules were designed to cover three key learning objectives and deployed in five sections. A pre- and post-training survey questionnaire was used to evaluate participants' self-assessments on employing PGx in clinical practice. Results and Conclusion: Out of all enrollments, 102 survey responses were collected. Overall, respondents agree on the benefits of PGx testing, but have inadequate self-efficacy and competency in utilizing PGx data. Our results show that a 90 min long training significantly improves these, and could lead to greater anticipation of PGx adoption.
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Affiliation(s)
| | | | | | | | - Sharon Goh
- Nalagenetics Pte Ltd, Singapore, Singapore
| | | | - Alexandre Chan
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California, Irvine, Irvine, CA, United States
| | - Astrid Irwanto
- Nalagenetics Pte Ltd, Singapore, Singapore.,Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
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Tillman EM, Beavers CJ, Afanasjeva J, Momary KM, Strnad KG, Yerramilli A, Williams AM, Smith BA, Florczykowski B, Fahmy M. Current and future state of clinical pharmacist‐led precision medicine initiatives. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Monica Fahmy
- American College of Clinical Pharmacy Lenexa Kansas USA
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Hicks JK, Howard R, Reisman P, Adashek JJ, Fields KK, Gray JE, McIver B, McKee K, O'Leary MF, Perkins RM, Robinson E, Tandon A, Teer JK, Markowitz J, Rollison DE. Integrating Somatic and Germline Next-Generation Sequencing Into Routine Clinical Oncology Practice. JCO Precis Oncol 2021; 5:PO.20.00513. [PMID: 34095711 PMCID: PMC8169076 DOI: 10.1200/po.20.00513] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/14/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
Next-generation sequencing (NGS) is rapidly expanding into routine oncology practice. Genetic variations in both the cancer and inherited genomes are informative for hereditary cancer risk, prognosis, and treatment strategies. Herein, we focus on the clinical perspective of integrating NGS results into patient care to assist with therapeutic decision making. Five key considerations are addressed for operationalization of NGS testing and application of results to patient care as follows: (1) NGS test ordering and workflow design; (2) result reporting, curation, and storage; (3) clinical consultation services that provide test interpretations and identify opportunities for molecularly guided therapy; (4) presentation of genetic information within the electronic health record; and (5) education of providers and patients. Several of these key considerations center on informatics tools that support NGS test ordering and referencing back to the results for therapeutic purposes. Clinical decision support tools embedded within the electronic health record can assist with NGS test utilization and identifying opportunities for targeted therapy including clinical trial eligibility. Challenges for project and change management in operationalizing NGS-supported, evidence-based patient care in the context of current information technology systems with appropriate clinical data standards are discussed, and solutions for overcoming barriers are provided.
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Affiliation(s)
- J. Kevin Hicks
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
| | - Rachel Howard
- Department of Health Informatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Phillip Reisman
- Department of Health Informatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jacob J. Adashek
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | - Karen K. Fields
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Clinical Pathways, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jhanelle E. Gray
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Bryan McIver
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Kelly McKee
- Department of Clinical Pathways, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Mandy F. O'Leary
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Randa M. Perkins
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Clinical Informatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Edmondo Robinson
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Internal Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ankita Tandon
- Department of Internal Medicine, University of South Florida, Tampa, FL
| | - Jamie K. Teer
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Joseph Markowitz
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Dana E. Rollison
- Department of Oncologic Sciences, University of South Florida, Tampa, FL
- Department of Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Liko I, Corbin L, Tobin E, Aquilante CL, Lee YM. Implementation of a pharmacist-provided pharmacogenomics service in an executive health program. Am J Health Syst Pharm 2021; 78:1094-1103. [PMID: 33772264 DOI: 10.1093/ajhp/zxab137] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We describe the implementation of a pharmacist-provided pharmacogenomics (PGx) service in an executive health program (EHP) at an academic medical center. SUMMARY As interest in genomic testing grows, pharmacists have the opportunity to advance the use of PGx in EHPs, in collaboration with other healthcare professionals. In November 2018, a pharmacist-provided PGx service was established in the EHP at the University of Colorado Hospital. The team members included 3 physicians, a pharmacist trained in PGx, a registered dietitian/exercise physiologist, a nurse, and 2 medical assistants. We conducted 4 preimplementation steps: (1) assessment of the patient population, (2) selection of a PGx test, (3) establishment of a visit structure, and (4) selection of a billing model. The PGx consultations involved two 1-hour visits. The first visit encompassed pretest PGx education, review of the patient's current medications and previous medication intolerances, and DNA sample collection for genotyping. After this visit, the pharmacist developed a therapeutic plan based on the PGx test results, discussed the results and plan with the physician, and created a personalized PGx report. At the second visit, the pharmacist reviewed the PGx test results, personalized the PGx report, and discussed the PGx-guided therapeutic plan with the patient. Overall, the strategy worked well; minor challenges included evaluation of gene-drug pairs with limited PGx evidence, communication of information to non-EHP providers, scheduling issues, and reimbursement. CONCLUSION The addition of a PGx service within an EHP was feasible and provided pharmacists the opportunity to lead PGx efforts and collaborate with physicians to expand the precision medicine footprint at an academic medical center.
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Affiliation(s)
- Ina Liko
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA
| | - Lisa Corbin
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO,USA
| | - Eric Tobin
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA
| | - Christina L Aquilante
- Department of Pharmaceutical Sciences, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA
| | - Yee Ming Lee
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO,USA
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Flynn AJ, Fortier C, Maehlen H, Pierzinski V, Runnebaum R, Sullivan M, Wagner J, Stevenson JG. A strategic approach to improving pharmacy enterprise automation: Development and initial application of the Autonomous Pharmacy Framework. Am J Health Syst Pharm 2021; 78:636-645. [PMID: 33585909 DOI: 10.1093/ajhp/zxab001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Allen J Flynn
- Department of Learning Health Sciences, Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | - Hanna Maehlen
- Independent Management Consultant, Kufstein, Austria
| | | | - Ranee Runnebaum
- Department of Pharmacy, LCMC Children's Hospital of New Orleans, New Orleans, LA, USA
| | - Mark Sullivan
- Vanderbilt University Hospital and Clinics, Nashville, TN, USA
| | - Jeff Wagner
- Pharmacy, Respiratory Care, and ECMO Services, Texas Children's Hospital, Houston, TX, USA
| | - James G Stevenson
- Omnicell, Mountain View, CA, and Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
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Mdinaradze DS, Kozlov IB, Pavlova KS, Kofiadi IA, Kurbacheva OM. Analysis of the polymorphic variants of ADRB2 gene association with the β2-agonists response in patients with a rare theratype of asthma. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Standard asthma therapy includes prescription of β2-agonists. Changes in the functional activity of β2-adrenergic receptor are associated with ADRB2 genepolymorphism and related to the low therapeutic response to β2-agonists. Identification of carriers of the clinically significant gene variants will help to avoidineffective treatment and prescribe an alternative therapy. This study aimed to assess clinical significance of the ADRB2 gene polymorphisms (Arg16Gly andGln27Glu) associated with the therapeutic response to β2-agonists in the group of asthma patients. We subjected a small group of adult nonsmoking patients(n = 21) with moderate asthma (III–IV stage of GINA) to clinical and genetic examination. The group included patients with the new theratype, those that poorlyrespond to β2-adrenergic drugs but significantly to M-cholinergic agonists. The first group included patients responding well to both salbutamol and ipratropiumbromide. The second group was comprised of the patients for whom salbutamol was not effective but who tested positive for response to ipratropium bromide. Theanalysis of distribution of polymorphic variants of Arg16Gly and Gln27Glu revealed no significant relationship between alleles and genotypes and the efficacy of β2-agonists(0.52 for the rs1042713 variant, p = 1.0; 1.0 for the rs1042714 variant, p = 0.74, respectively). The genotype of patients that did not respond to salbutamol waseither Arg16Gly or Gly16Gly. Further studies are needed that would involve a larger number of patients and an expanded list of the tested polymorphic variants.
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Affiliation(s)
- DS Mdinaradze
- National Research Center Institute of Immunology of the Federal Medical-Biological Agency, Moscow, Russia
| | - IB Kozlov
- National Research Center Institute of Immunology of the Federal Medical-Biological Agency, Moscow, Russia
| | - KS Pavlova
- National Research Center Institute of Immunology of the Federal Medical-Biological Agency, Moscow, Russia
| | - IA Kofiadi
- National Research Center Institute of Immunology of the Federal Medical-Biological Agency, Moscow, Russia
| | - OM Kurbacheva
- National Research Center Institute of Immunology of the Federal Medical-Biological Agency, Moscow, Russia
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30
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Bright D, Saadeh C, DeVuyst-Miller S, Sohn M, Choker A, Langerveld A. Pharmacist Consult Reports to Support Pharmacogenomics Report Interpretation. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2020; 13:719-724. [PMID: 33328756 PMCID: PMC7735940 DOI: 10.2147/pgpm.s276687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
Background The clinical implementation of pharmacogenomics (PGx) has often involved teams that include pharmacists. PGx laboratories often provide baseline information within the laboratory report that is based on Food and Drug Administration and Clinical Pharmacogenomics Implementation Consortium guidance, but information is often provided independent of concurrent disease states or medication use, among other clinical factors. Major challenges to widescale implementation of PGx include lack of physician experience or confidence in interpreting the data. The purpose of this paper is to describe how pharmacists can help further personalize PGx information and identify clinical recommendations for a given patient. Methods This work was performed as a secondary objective of a study evaluating genetic biomarkers of opioid addiction risk. This portion of the study utilized a descriptive analysis of pharmacist consult reports that consist of individualized, patient-level clinical recommendations that take into account current medications, current health conditions, and PGx data. A panel of 60 common PGx targets were tested among patients being treated for chronic pain or opioid use disorder (OUD). A pharmacist consult report was generated and compared with standard laboratory reporting of general PGx information. Results Of the 252 patients, PGx reports for 198 (78.6%) contained red and/or yellow clinical decision support flags for medications with actionable or informative PGx guidance for currently prescribed medications. Pharmacists recommended modifications to current prescriptions for 31 (53%) of the patients with actionable flags and 17 (12%) of the patients with informative flags. Drug classes most commonly included medications for cardiology, depression and anxiety, pain (opioids) and gastrointestinal management. Taken together, 24.2% of the actionable and informative flags had immediate clinical value based on the pharmacist’s review. An additional 217 (86%) received one or more clinical recommendations not related to PGx. Conclusion While PGx provides another opportunity for pharmacotherapy personalization, PGx data must be considered within the context of other patient-specific factors. Pharmacists were able to streamline the PGx report flags and identify other pharmacotherapy interventions following application of patient-specific data, thereby developing a brief report of recommendations for the patient’s prescriber(s). Engaging clinical pharmacists in the PGx clinical decision process may help to facilitate more widespread PGx implementation.
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Affiliation(s)
- David Bright
- Department of Pharmaceutical Sciences, Ferris State University College of Pharmacy, Big Rapids, MI 49307, USA
| | - Claire Saadeh
- Ferris State University College of Pharmacy, Big Rapids, MI 49307, USA
| | | | - Minji Sohn
- Department of Pharmaceutical Sciences, Ferris State University College of Pharmacy, Big Rapids, MI 49307, USA
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31
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Gammal RS, Nguyen J, Audi E, Lee YM, Petry N, Empey PE. Advanced Pharmacy Practice Experiences in Pharmacogenomics Offered by US Pharmacy Programs. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:ajpe8031. [PMID: 34283786 PMCID: PMC7779881 DOI: 10.5688/ajpe8031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/19/2020] [Indexed: 05/02/2023]
Abstract
Objective. To characterize advanced pharmacy practice experiences (APPEs) with a primary focus in pharmacogenomics at schools and colleges of pharmacy in the United States.Methods. This was a cross-sectional, multicenter, observational study of pharmacogenomics APPEs at US pharmacy schools. Directors of experiential education at 146 accredited schools of pharmacy were contacted by phone and asked if their school offered a pharmacogenomics APPE. The preceptors of pharmacogenomics APPEs identified by this phone screen were sent an email with a link to an online survey that asked about their APPE offerings.Results. Of the 142 schools of pharmacy that were successfully reached via phone, 40 (28%) offered an APPE with a primary focus in pharmacogenomics. Thirty unique APPEs with pharmacogenomics as a primary focus were identified. The total number of preceptors involved in the pharmacogenomics APPEs was 33: 19 (58%) faculty preceptors and 14 (42%) non-faculty preceptors. Twenty-three of the 30 pharmacogenomics APPEs completed the survey (77% response rate). The APPE sites were diverse and included academic medical centers, community health systems, pharmacogenomic testing laboratories, and schools of pharmacy. Each pharmacogenomics APPE accommodated an average of six students per year. The APPE activities varied across sites.Conclusion. Only a small number of US pharmacy schools offer an APPE with a primary focus in pharmacogenomics. These rotations are diverse in scope and precepted by faculty or non-faculty pharmacists. The Academy should pursue opportunities to increase experiential education in pharmacogenomics.
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Affiliation(s)
| | - Jenny Nguyen
- MCPHS University, School of Pharmacy, Boston, Massachusetts
| | - Elaina Audi
- MCPHS University, School of Pharmacy, Boston, Massachusetts
| | - Yee Ming Lee
- University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado
| | - Natasha Petry
- North Dakota State University, School of Pharmacy, Fargo, North Dakota
| | - Philip E Empey
- University of Pittsburgh, School of Pharmacy, Pittsburgh, Pennsylvania
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32
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Varughese LA, Lau-Min KS, Cambareri C, Damjanov N, Massa R, Reddy N, Oyer R, Teitelbaum U, Tuteja S. DPYD and UGT1A1 Pharmacogenetic Testing in Patients with Gastrointestinal Malignancies: An Overview of the Evidence and Considerations for Clinical Implementation. Pharmacotherapy 2020; 40:1108-1129. [PMID: 32985005 PMCID: PMC8796462 DOI: 10.1002/phar.2463] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gastrointestinal (GI) malignancies are among the most commonly diagnosed cancers worldwide. Despite the introduction of targeted and immunotherapy agents in the treatment landscape, cytotoxic agents, such as fluoropyrimidines and irinotecan, remain as the cornerstone of chemotherapy for many of these tumors. Pharmacogenetics (PGx) is a rapidly evolving field that accounts for interpatient variability in drug metabolism to predict therapeutic response and toxicity. Given the significant incidence of severe treatment-related adverse events associated with cytotoxic agents, utilizing PGx can allow clinicians to better anticipate drug tolerability while minimizing treatment interruptions or delays. In this review, the PGx profiles of drug-gene pairs with potential impact in GI malignancy therapy - DPYD-5-fluorouracil/capecitabine and UGT1A1-irinotecan - and the available clinical evidence of their roles in reducing severe adverse events are discussed. Considerations for clinical implementation, such as optimal laboratory workflows, electronic health record integration, and stakeholder engagement, as well as provider education, are addressed. Last, exploratory PGx markers in GI malignancy treatment are described. As the PGx knowledge base rapidly evolves, pharmacists will be vital in leveraging their pharmacology knowledge and clinical skills to implement PGx testing in the clinic.
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Affiliation(s)
- Lisa A. Varughese
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelsey S. Lau-Min
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine Cambareri
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nevena Damjanov
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan Massa
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandi Reddy
- Ann B. Barshinger Cancer Institute, Penn Medicine at Lancaster General Health, Lancaster, Pennsylvania
| | - Randall Oyer
- Ann B. Barshinger Cancer Institute, Penn Medicine at Lancaster General Health, Lancaster, Pennsylvania
| | - Ursina Teitelbaum
- Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sony Tuteja
- Division of Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Smith DM, Namvar T, Brown RP, Springfield TB, Peshkin BN, Walsh RJ, Welsh JC, Levin B, Brandt N, Swain SM. Assessment of primary care practitioners' attitudes and interest in pharmacogenomic testing. Pharmacogenomics 2020; 21:1085-1094. [PMID: 32969759 DOI: 10.2217/pgs-2020-0064] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Aims: Identify the attitudes and interests of primary care providers (PCPs) in applying clinical pharmacogenomics (PGx) test results. Materials & methods: A questionnaire was designed and then disseminated to PCPs across the MedStar Health System. Results: Ninety of 312 (29%) PCPs responded and were included in analyses. Seventy-six (84%) had heard of PGx and 12 (13%) previously ordered PGx testing. Most, 68 (76%), believed PGx can improve care; however, a minority, 23 (26%), reported confidence in using PGx in prescribing decisions. Sixty-four (70%) wanted a pharmacist consultation. PCPs desired PGx for antidepressants (75%), proton pump inhibitors (72%) and other medications. Conclusion: Most PCPs felt unprepared to interpret PGx results and desired pharmacist consultations. These data can inform future PGx implementations with PCPs.
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Affiliation(s)
- D Max Smith
- MedStar Health, Columbia, MD 21044, USA.,Georgetown University Medical Center, Washington, DC 20057, USA
| | - Tarlan Namvar
- University of Maryland School of Pharmacy, Lamy Center, MD 212014, USA
| | | | | | - Beth N Peshkin
- Georgetown University Medical Center, Washington, DC 20057, USA
| | | | | | | | - Nicole Brandt
- University of Maryland School of Pharmacy, Lamy Center, MD 212014, USA.,MedStar Center for Successful Aging, Baltimore, MD 21239, USA
| | - Sandra M Swain
- MedStar Health, Columbia, MD 21044, USA.,Georgetown University Medical Center, Washington, DC 20057, USA
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Rodríguez-Escudero I, Cedeño JA, Rodríguez-Nazario I, Reynaldo-Fernández G, Rodríguez-Vera L, Morales N, Jiménez-Vélez B, Ruaño G, Duconge J. Assessment of the clinical utility of pharmacogenetic guidance in a comprehensive medication management service. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020; 3:1028-1037. [PMID: 32964197 PMCID: PMC7505210 DOI: 10.1002/jac5.1250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/12/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Pharmacists are poised to be the health care professionals best suited to provide medication-related consults and services based on a patient's genetics. Despite its potential benefits, the implementation of pharmacogenetic (PGx) testing into primary clinical settings has been slow among medically underserved populations. To our knowledge, this is the first time that PGx-driven recommendations have been incorporated into a Comprehensive Medication Management (CMM) service in a Hispanic population. OBJECTIVES The aim of this study is to evaluate the clinical utility of adding PGx guidance into pharmacist-driven CMM. METHODS This is a pre- and post-interventional design study. Patients were recruited from a psychologist's clinic. A total of 24 patients had a face-to-face interview with a pharmacist to complete a CMM, Personal Medication Record, and Medication-Related Action Plan (MAP) blind to PGx findings. Collected buccal DNA samples were genotyped using drug-metabolizing enzymes and transporters (DMET) Plus Array. RESULTS The pharmacist generated new MAPs for each patient based on PGx results. Genetic variants that could potentially affect the safety and effectiveness of at least one drug in the pharmacotherapy were identified in 96% of patients, for whom the pharmacist changed the initial recommendations. Polymorphisms in genes encoding for isoenzymes CYP2D6, CYP2C19, and CYP2C9 were identified in 83%, 52%, and 41% of patients, respectively. Pharmacists performing CMM identified 22 additional medication problems after PGx determinations. Moreover, they agreed with the clinical utility of PGx in the studied sample based on perceived value of adding PGx to traditional CMM and its utility in the decision-making process of pharmacists. CONCLUSIONS The study confirmed the critical role to be played by pharmacists in facilitating the clinical usage of relevant genetic information to optimize drug therapy decisions as well as their involvement on many levels of these multidisciplinary implementation efforts, including championing and leading PGx-guided CMM services.
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Affiliation(s)
| | - Julio A. Cedeño
- School of Pharmacy, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | | | | | | | | | - Braulio Jiménez-Vélez
- Department of Biochemistry, University of Puerto Rico, Medical Sciences Campus, School of Medicine, San Juan, Puerto Rico
| | - Gualberto Ruaño
- Institute of Living at Hartford Hospital, Laboratory of Personalized Health, Genomas, Inc., Hartford, Connecticut
| | - Jorge Duconge
- School of Pharmacy, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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35
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Deininger KM, Tsunoda SM, Hirsch JD, Anderson H, Lee YM, McIlvennan CK, Page RL, Tran JN, Aquilante CL. National survey of physicians' perspectives on pharmacogenetic testing in solid organ transplantation. Clin Transplant 2020; 34:e14037. [PMID: 32654213 DOI: 10.1111/ctr.14037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Our objective was to evaluate physicians' perspectives on the clinical utility of pharmacogenetic (PGx) testing in kidney, liver, heart, and lung transplantation (KLHL-Tx). METHODS A 36-question web-based survey was developed and administered to medical and surgical directors of US KLHL-Tx centers. RESULTS There were 82 respondents (10% response rate). The majority were men (78%), non-Hispanic whites (70%), medical directors (72%), and kidney transplant physicians (35%). Although 78% of respondents reported having some PGx education, most reported lack of confidence in their PGx knowledge and ability to apply a PGx test. Participants reported mixed views about the clinical utility of PGx testing-most agreed with the efficacy of PGx testing, but not the benefits relative to the risks or standard of care. While 55% reported that testing was available at their institution, only 38% ordered a PGx test in the past year, most commonly thiopurine-S-methyltransferase. Physician-reported barriers to PGx implementation included uncertainty about the clinical value of PGx testing and patient financial burden. CONCLUSION Together, our findings suggest prospective PGx research and pilot implementation programs are needed to elucidate the clinical utility and value of PGx in KLHL-Tx. These initiatives should include educational efforts to inform the use of PGx testing.
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Affiliation(s)
- Kimberly M Deininger
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Shirley M Tsunoda
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
| | - Jan D Hirsch
- Department of Pharmaceutical Sciences, University of California Irvine, Irvine, CA, USA
| | - Heather Anderson
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Yee Ming Lee
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Colleen K McIlvennan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert L Page
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Jacinda N Tran
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA
| | - Christina L Aquilante
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
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